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Over 50 genes are inducible by hypoxia, via hypoxia inducible factor 1α (HIF-1α). Carbonic anhydrase IX (CAIX) is one of the most inducible and most uniformly induced genes and because of its stability and membrane location provides a reliable histochemical marker of hypoxia. Recent studies have shown the importance of pH in cell death under hypoxia; thus mechanisms of pH regulation are likely to be vital pathways for survival. Carbonic anhydrases have a widespread role in normal tissues in regulating pH, with 14 isoforms described, so inhibition may have substantial normal tissue toxicity. Selective nonmembrane permeable inhibitors are available and may synergize with chemotherapy agents more active in acid conditions. CAIX has a major role in regulating hydrogen ion (H+) flux and blockade of CAIX results in increased cell death under hypoxia, indicating that it is one mechanism of hypoxic adaptation. As it is commonly expressed in tumors with the worst prognosis it is a potential target for therapy. © L a n d e s B i o s c i e n c e 2 0 0 4. N o t f o r d i s t r i b u t i o n .

Carbonic anhydrase IX (CAIX) is a membrane-associated carbonic anhydrase (CA), strongly induced by hypoxia. CAIX is overexpressed in a variety of tumor types and associated with increased metastasis and poor prognosis. An inhibitor of CAs, acetazolamide has been reported to inhibit invasion. We used RNA interference (RNAi) to examine the function of CAIX in MDA468 and MDA231 breast carcinoma cells, which express high levels of CAIX under hypoxia. Hypoxia-induced CA activity was completely blocked by specific RNAi (P < 0.01). RNAi-treated cells showed growth delay in dense monolayer culture and a 50% reduction in clonogenic survival under hypoxia. In the MDA468 cells, there was no effect of RNAi treatment on invasion. In a cell line that did not induce CAIX under hypoxia, RT112, we found no effect on the ability of cells transfected with CAIX to invade or migrate. Thus, CAIX plays an important role in the growth and survival of tumor cells under normoxia and hypoxia, making it a potential target for cancer therapy, but is not involved in invasion.

Significant improvements in both hearing and quality of life are achievable in patients with end-stage obliterative otitis externa treated surgically. Highly trained and competent aural care practitioners are a prerequisite for the success of the procedure, and a substantial number of patients must be prepared to submit to long-term follow-up care.

Cardiac metastasis from head and neck cancer is rarely encountered. We present a base-of-tongue squamous cell carcinoma with metastasis to the heart that was diagnosed antemortem. Autopsy series indicate that tongue cancer may metastasize more frequently to the heart than from other head and neck sites. However, none of these studies was controlled. Most importantly, cardiac metastasis should be suspected in any patient with cancer in whom new cardiac symptoms develop. The diagnosis is best confirmed with two-dimensional echocardiography or cardiac MRI. A myocardial or endocardial biopsy specimen can be obtained with angiographic guidance. Despite the improvement in diagnostic capability, available treatments are only palliative. All patients eventually die of their metastatic disease.

A 79-year-old man, with a history of well-controlled diabetes mellitus, presented with left-sided otalgia. With an initial diagnosis of simple otitis externa, he was discharged on topical drops. He represented 2 months later with worsening otalgia and discharge. A diagnosis of malignant otitis externa was made based on clinical and radiological findings. Intravenous Tazocin and Gentamicin were given based on previous bacterial culture from ear swabs. The patient failed to improve and developed left-sided facial nerve palsy. His condition stabilised following a change in antimicrobial therapy and his management continued in the community on intravenous Meropenem with twice weekly aural toilet. Repeated nuclear medicine imaging failed to demonstrate resolution. A bony sequestration was removed from the external auditory canal in the outpatient clinic, which following extended culture grew Scedosporium apiospermum; his management was subsequently changed to oral Voriconazole. This led to rapid clinical improvement and disease resolution over a 6 -week period.

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